Hyperoxaluria Is a Long-Term Consequence of Roux-en-Y Gastric Bypass: A 2-Year Prospective Longitudinal Study

Duffey, Branden G.; Alanee, Shaheen; Pedro, Renato N.; Hinck, Bryan; Kriedberg, Carly; Ikramuddin, Sayeed; Kellogg, Todd A.; Stessman, Michelle; Moeding, Angela; Monga, Manoj

doi:10.1016/j.jamcollsurg.2010.03.007

Cited by 69 publications

(68 citation statements)

References 37 publications

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“…It may also have occurred because calcium supplements were withdrawn 3 days before urine collection in our study. Hypomagnesuria was not frequent in our series of post-BS patients, which was also the case in several other studies (5,7,(9)(10)(11)(12). This is most likely because magnesium depletion is more commonly due to diarrhea, which was detected in only two post-BS patients (one RYGB and one BD-DS).…”

Section: Discussionsupporting

confidence: 82%

“…Hypocitraturia is not a uniform finding after BS (5,6,8,10,11). This study detected hypocitraturia in 34% of patients, which is similar to that reported by Park et al (7) (31%) but is lower than other studies that reported prevalence rates from 44% to 63% (9,12,28). The reasons for hypocitraturia after BS in these studies have not been fully elucidated.…”

Section: Discussionsupporting

confidence: 71%

“…Several recent studies demonstrated that urinary abnormalities, such as low urine volume, hypocitraturia, and more commonly, hyperoxaluria, may predispose bariatric patients to nephrolithiasis (4)(5)(6)(7)(8)(9)(10)(11)(12). Hyperoxaluria is the most frequent lithogenic factor detected in the majority of studies, with prevalence rates between 29% and 74% (4)(5)(6)(7)(8)(9)(10)(11)(12) and time to onset of 3-24 months after the procedure (8,9). The potential underlying mechanisms for hyperoxaluria have not yet been determined, but some degree of fat malabsorption is speculated to play a role through the binding of fatty acids to calcium, thereby inhibiting the formation of poorly soluble, nonabsorbable calcium oxalate in the intestinal lumen (11,13).…”

Section: Introductionmentioning

confidence: 99%

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Response to Dietary Oxalate after Bariatric Surgery

Froeder

Arasaki

Malheiros³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Bariatric surgery (BS) may be associated with increased oxalate excretion and a higher risk of nephrolithiasis. This study aimed to investigate urinary abnormalities and responses to an acute oxalate load as an indirect assessment of the intestinal absorption of oxalate in this population.Design, setting, participants, & measurements Twenty-four-hour urine specimens were collected from 61 patients a median of 48 months after BS (post-BS) as well as from 30 morbidly obese (MO) participants; dietary information was obtained through 24-hour food recalls. An oral oxalate load test (OLT), consisting of 2-hour urine samples after overnight fasting and 2, 4, and 6 hours after consuming 375 mg of oxalate (spinach juice), was performed on 21 MO and 22 post-BS patients 12 months after BS. Ten post-BS patients also underwent OLT before surgery (pre-BS).Results There was a higher percentage of low urinary volume (,1.5 L/d) in post-BS versus MO (P,0.001). Hypocitraturia and hyperoxaluria (P=0.13 and P=0.36, respectively) were more frequent in BS versus MO patients. The OLT showed intragroup (P,0.001 for all periods versus baseline) and intergroup differences (P,0.001 for post-BS versus MO; P=0.03for post-BS versus pre-BS). The total mean increment in oxaluria after 6 hours of load, expressed as area under the curve, was higher in both post-BS versus MO and in post-BS versus pre-BS participants (P,0.001 for both).Conclusions The mean oxaluric response to an oxalate load is markedly elevated in post-bariatric surgery patients, suggesting that increased intestinal absorption of dietary oxalate is a predisposing mechanism for enteric hyperoxaluria.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Response to Dietary Oxalate after Bariatric Surgery

Froeder

Arasaki

Malheiros³

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Some detailed analyses of the hyperoxaluria occurring after bariatric surgery have been performed by measuring urinary oxalate excretion in 24-h urine collections [9][10][11][12][13][14][15][16]. Duffey et al [10,11] conducted a long-term prospective study of the hyperoxaluria after R-Y gastric bypass, and revealed that the postoperative mean urinary oxalate excretion was significantly elevated from baseline at 3 months, and continued to grow in magnitude, reaching a stable level 1-2 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Duffey et al [10,11] conducted a long-term prospective study of the hyperoxaluria after R-Y gastric bypass, and revealed that the postoperative mean urinary oxalate excretion was significantly elevated from baseline at 3 months, and continued to grow in magnitude, reaching a stable level 1-2 years after surgery. There are other studies indicating that the mean intervals from surgery to the Table 4).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

et al. 2012

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Background Roux-en-Y (R-Y) gastric bypass, also known as bariatric surgery, sometimes causes postoperative hyperoxaluria and subsequent oxalate nephrolithiasis in obese patients. In this study, we retrospectively investigated the frequency of occurrence of nephrolithiasis and renal dysfunction in postoperative gastric cancer patients with respect to the surgical procedures employed. Methods Two hundred and twenty-six consecutive gastric cancer patients, who underwent distal gastrectomy with Billroth-I reconstruction (DGBI, 60 patients), distal gastrectomy with R-Y reconstruction (DGRY, 81 patients), and total gastrectomy with R-Y reconstruction (TGRY, 85 patients), were investigated for postoperative nephrolithiasis and renal dysfunction. We also examined the risk factors for postoperative nephrolithiasis in these patients with gastric cancer. Results Nephrolithiasis was detected in 3 (5 %), 7 (9 %), and 21 (25 %) patients in the DGBI, DGRY, and TGRY groups, respectively. There were significant differences in the frequency of nephrolithiasis between the DGBI and TGRY groups (p = 0.004), and between the DGRY and TGRY groups (p = 0.011), but there was no significant difference between the DGBI and DGRY groups. Multivariate logistic regression analysis revealed that gender and extent of gastrectomy were independent risk factors associated with nephrolithiasis. Renal dysfunction was found in 5 patients (6 %) in the TGRY group, but was not found in either the DGBI or the DGRY group. Nephrolithiasis was detected in all these 5 patients, and a renal biopsy performed in one patient revealed the presence of intratubular calcium oxalate crystals with chronic tubulointerstitial nephritis. Conclusion Total gastrectomy with R-Y reconstruction was an independent predictive factor for nephrolithiasis in patients with gastric cancer.

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Association of Urinary Oxalate Excretion With the Risk of Chronic Kidney Disease Progression

et al. 2019

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; for the Chronic Renal Insufficiency Cohort study investigators IMPORTANCE Oxalate is a potentially toxic terminal metabolite that is eliminated primarily by the kidneys. Oxalate nephropathy is a well-known complication of rare genetic disorders and enteric hyperoxaluria, but oxalate has not been investigated as a potential contributor to more common forms of chronic kidney disease (CKD). OBJECTIVE To assess whether urinary oxalate excretion is a risk factor for more rapid progression of CKD toward kidney failure. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study assessed 3123 participants with stages 2 to 4 CKD who enrolled in the Chronic

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Hyperoxaluria Is a Long-Term Consequence of Roux-en-Y Gastric Bypass: A 2-Year Prospective Longitudinal Study

Cited by 69 publications

References 37 publications

Response to Dietary Oxalate after Bariatric Surgery

Response to Dietary Oxalate after Bariatric Surgery

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

Association of Urinary Oxalate Excretion With the Risk of Chronic Kidney Disease Progression

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